Document Detail

A comprehensive review of epinephrine in the finger: to do or not to do.
MedLine Citation:
PMID:  11420511     Owner:  NLM     Status:  MEDLINE    
The prohibition against the use of local anesthetics with epinephrine for digital blocks or infiltration is an established surgical tradition. The present article provides a comprehensive review of all reported digital necrotic and ischemic complications with epinephrine in the digits in an effort to understand whether the current prohibition is based on documented reports. A comprehensive review of articles showing the successful use of local anesthetic with epinephrine in the digits is presented.A review of Index Medicus from 1880 to 1966 and a computer review of the National Library of Medicine database from 1966 to 2000 were performed using multiple keywords. Selected major textbooks from 1900 to 2000 were also reviewed.A total of 48 cases of digital gangrene after anesthetic blocks (mostly using cocaine or procaine) have been reported in the world literature. Only 21 cases involved the use of epinephrine; 17 involved an unknown concentration based on manual dilution. Multiple other concurrent conditions (hot soaks, tight tourniquets, and infection) existed in these case reports, making it difficult to determine the exact cause of the tissue insult. There have been no case reports of digital gangrene using commercial lidocaine with epinephrine (introduced in 1948). Multiple studies involving thousands of patients support the premise that the use of lidocaine with epinephrine is safe in the digits. An extensive literature review failed to provide consistent evidence that our current preparations of local anesthesia with epinephrine cause digital necrosis, although not all complications are necessarily reported. However, as with all techniques, caution is necessary to balance the risks of this technique with the dangers of mechanical tourniquets and upper extremity block anesthesia.
K Denkler
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  108     ISSN:  0032-1052     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-06-22     Completed Date:  2001-07-26     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  114-24     Citation Subset:  AIM; IM    
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MeSH Terms
Anesthesia, Local*
Anesthetics, Local / administration & dosage*
Epinephrine / administration & dosage,  adverse effects*,  contraindications
Fingers / blood supply*,  innervation,  pathology
Gangrene / chemically induced
Ischemia / chemically induced*
Vasoconstrictor Agents / administration & dosage,  adverse effects*,  contraindications
Reg. No./Substance:
0/Anesthetics, Local; 0/Vasoconstrictor Agents; YKH834O4BH/Epinephrine
Comment In:
Plast Reconstr Surg. 2002 Sep 1;110(3):999; author reply 999-1000   [PMID:  12172185 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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